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Jamaica Support for the Health Systems

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Jamaica Support for the Health Systems CONFIDENTIAL INTERNAL USE PUBLIC UPON APPROVAL DOCUMENT OF THE INTER-AMERICAN DEVELOPMENT BANK JAMAICA SUPPORT FOR THE HEALTH SYSTEMS STRENGTHENING FOR THE PREVENTION AND CARE MANAGEMENT OF NON-COMMUNICABLE DISEASES PROGRAMME II (JA-L1086) LOAN PROPOSAL This document was prepared by the project team consisting of: Ricardo Pérez Cuevas (SPH/CJA) and Pablo Ibarrarán (SCL/SPH) CoTeam- Leaders; Ian Mac Arthur (SPH/CBR); Jennifer Nelson, Isabel Delfs Ilieva, and Sheyla Silveira (SCL/SPH); Rene Herrera, and Naveen Jainauth-Umrao (FMP/CJA); Henry Mooney, Jason Craig Christie, and Nicole Brown (CCB/CJA); Louis Francois- Chrétien (LEG/SGO); and Charles Steven Collins (VPS/ESG). This document contains confidential information relating to one or more of the ten exceptions of the Access to Information Policy and will be initially treated as confidential and made available only to Bank Employees. The document will be discussed and made available to the public upon approval. CONTENTS PROJECT SUMMARY ................................................................................................................... 1 I. PROJECT DESCRIPTION AND RESULTS MONITORING ......................................................... 2 A. Background, problem addressed, and justification .............................................. 2 B. Objective, components, and cost........................................................................ 17 C. Key results indicators .......................................................................................... 20 II. FINANCING STRUCTURE AND MAIN RISKS ....................................................................... 21 A. Financing instruments ......................................................................................... 21 B. Environmental and social risks ........................................................................... 21 C. Fiduciary risk........................................................................................................ 22 D. Other key issues and risks .................................................................................. 22 III. IMPLEMENTATION AND MANAGEMENT PLAN .................................................................... 22 A. Summary of implementation arrangements ....................................................... 22 B. Summary of arrangements for monitoring results .............................................. 23 IV. POLICY LETTER ............................................................................................................... 23 - ii - ANNEXES Annex I Summary Development Effectiveness Matrix (DEM) Annex II Policy Matrix Annex III Results Matrix REQUIRED ELECTRONIC LINKS (REL) REL#1 Policy Letter REL#2 Means of Verification REL#3 Monitoring and Evaluation Arrangements OPTIONAL ELECTRONIC LINKS (OEL) OEL#1 Comparative Matrix OEL#2 Loan Proposal First Operation JA-L1080 OEL#3 References - iii - ABBREVIATIONS BFHI Baby-Friendly Hospital Initiative CCM Chronic Care Model DALYs Disability Adjusted Life Years DFID United Kingdom Department for International Development EBP Essential Benefit Package ECHO Extension for Community Healthcare Outcomes ESMR Environmental and Social Management Report ESS Environmental and Social Strategy FCTC Framework Convention on Tobacco Control FY Fiscal Year GDP Gross Domestic Product HIMS Hospital Information Management System HIV Human Immunodeficiency Virus IDB Inter-American Development Bank IMF International Monetary Fund IS4H Information Systems for Health JHLS III Jamaica Health and Lifestyle Survey LB Live Births MNDs Mental and Neurological Disorders MOHW Ministry of Health and Wellness NCD Non-Communicable Diseases NFITF National Food Industry Task Force NHI National Health Insurance NHIP National Health Insurance Plan NIR Nominal Interest Rate NMHAP National Mental Health Action Plan NSAP-NCD National Strategic and Action Plan for the Prevention and Control of Non- Communicable Diseases PAHO Pan American Health Organization PBL Policy-based loan PBP Programmatic policy-based loan POD Proposal for Operation Development PROMAC Programme for the Reduction of Maternal and Child Mortality SPF Safeguard Policy Filter SSF Safeguard Screening Form TCL Tobacco Control Legislation UNOPS United Nations Office for Project Services WHO World Health Organization YLLs Years of Life Lost PROJECT SUMMARY JAMAICA SUPPORT FOR THE HEALTH SYSTEMS STRENGTHENING FOR THE PREVENTION AND CARE MANAGEMENT OF NON-COMMUNICABLE DISEASES PROGRAMME II (JA-L1086) Financial Terms and Conditions Borrower Flexible Financing Facility (a) Jamaica Amortization Period: 20 Years Executing Agency Disbursement Period: 1 Year Ministry of Finance and the Public Service (MOFPS) Grace Period: 5.5 Years (b) Source Amount (US$) % Interest rate: LIBOR Based Credit Fee: (c) IDB (Ordinary Capital 100,000,000 100 Inspection and supervision fee: (c) OC): Weighted Average Life (WAL): 12.75 years Dollars of the United Total: 100,000,000 100 Currency of Approval: States of America Project at a Glance Project objective/description: The objective of this Programme is to contribute to the improvement of the health of Jamaica’s population by strengthening comprehensive policies for the reduction of Non-Communicable (Chronic) Diseases (NCDs) risk factors and improved access to an upgraded and integrated primary and secondary health network in prioritized areas with an emphasis on chronic disease management, that provide more efficient and higher quality care. Within the overall programme, the specific development objectives of the second operation of the PBP are: (i) to promote regulatory and policy measures for the reduction of risk factors that cause NCDs; and (ii) to promote regulatory and policy measures to improve NCD early detection and clinical management. This policy-based loan (PBL) is the second of a programmatic PBL series, made up of two contractually independent and technically linked loans, as per document Policy-based Loans Guidelines for Preparation and Implementation (CS-3633-2). Special contractual clauses prior to the first disbursement: The single disbursement of loan resources will be subject to the Borrower’s compliance with the policy conditions of the second operation summarized in the Policy Matrix (Annex II) and the Policy Letter (REL#1), as well as the compliance with the conditions contained in the loan contract (¶3.3). Exceptions to Bank Policies: None. Strategic Alignment Challenges(d): SI ☒ PI ☐ EI ☐ Cross-Cutting Themes(e): GD ☒ CC ☐ IC ☒ (a) Under the Flexible Financing Facility (FN-655-1), the borrower has the option to request modifications to the amortization schedule, as well as currency, interest rate and commodity conversions. In considering such requests, the Bank will take into account operational and risk management considerations. (b) Under the flexible repayment options of the Flexible Financing Facility (FFF), changes in the grace period are possible as long the Original Weighted Average Life (WAL) and the last payment date, as documented in the loan agreement, are not exceeded. (c) The credit fee and inspection and supervision fee will be established periodically by the Board of Executive Directors during its review of the Bank’s lending charges, in accordance with the relevant policies. (d) SI (Social Inclusion and Equality); PI (Productivity and Innovation); and EI (Economic Integration). (e) GD (Gender Equality and Diversity); CC (Climate Change and Environmental Sustainability); and IC (Institutional Capacity and Rule of Law). - 2 - I. PROJECT DESCRIPTION AND RESULTS MONITORING A. Background, problem addressed, and justification 1.1 In November 2018, the Board of Directors of the Inter-American Development Bank (IDB) approved the hybrid operation for Jamaica including the first of two Programmatic policy-based loans (PBP) ‘‘Support for the Health Systems Strengthening for the Prevention and Care Management of Non-Communicable Diseases Programme (JA-L1080; 4669/OC-JA)’’ for US$50 million, and an investment loan for US$50 million (JA-L1049; 4668/OC-JA).’’ Additionally, in 2019, the European Union Caribbean Investment Facility (EU-CIF) approved a €10 million investment grant ‘‘Support for the Health Systems Strengthening for the Prevention and Care Management of Non-communicable Diseases Programme (JA-G1005; GRT/ER-17830-JA)’’ to improve the quality of primary care provided through health centers in the catchment areas of the hospitals selected for IDB investments, as well as patient adherence to chronic non-communicable diseases (NCD) management protocols. Together, the PBP, the investment loan and the investment grant comprise the “Support for the Health Systems Strengthening for the Prevention and Care Management of Non-Communicable Diseases Programme.” 1.2 This document proposes the approval of the second operation of the PBP series. The first operation of the series supported the formulation of regulatory frameworks aimed at reducing the risk factors for NCDs, and aligned health policies, guidelines, and protocols to manage NCDs efficiently. This second operation that completes the PBP consolidates the approval and implementation of the public health policies to reduce the risk factors and improve early detection and clinical management of NCDs. 1.3 Jamaica has concluded its tenure with the International Monetary Fund (IMF) reform agreement and has made significant progress towards achieving a stable macroeconomic environment and debt sustainability since 2013 under two IMF agreements.
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